With the increasing popularity of electronic health records (EHR software), you’ve most likely heard of an EHR incentive program — government incentives that come with the implementation and use of such systems. While software solutions already provide a number of advantages for a variety of health organizations, these monetary incentives provide additional benefits for healthcare professionals.

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An EHR incentive program is a means of compensating healthcare providers for the costs associated with implementing and upgrading their EHR software. These systems are useful tools that allow for better standardization and accessibility of important patient health records nationwide. These incentive programs are available to eligible medical and health professionals who demonstrate meaningful use of certified EHR technology over the course of the next five to 10 years.

Benefits of EHR Software

EHR vendors have created helpful platforms that provide a variety of highly relevant databases and tools for healthcare providers. This software provides an integrated way for providers to manage all patient information, order tests, track individualized care plans and more.

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Purpose of an Incentive Program

CMS established Medicare and Medicaid EHR Incentive Programs — now known as Promoting Interoperability Programs (PI) — in an effort to encourage clinicians and organizations to adopt, implement and demonstrate meaningful use. While the adoption and use of EHR software has already been increasing at a fast rate, these incentive programs help to accelerate the adoption process and help meet program requirements.

To put it simply, an incentive program provides an annual payout to healthcare professionals who adopt EHR software into their practices. These financial incentives help providers meet the costs of upgrading their technology and give them an opportunity to stay ahead of the curve. The amount of their payout depends on the type of facility that is applying for the incentive and is also reliant on their ability to meet the meaningful use criteria set forth, which we’ll get into in a bit.

Promote Interoperability

As the new name of these incentives (Promoting Interoperability Programs) would suggest, driving interoperability is a primary reason for these stimulus initiatives. Interoperability involves the exchange of information between multiple healthcare providers. These providers are able to exchange patient data and other sensitive information regardless of the different EHR systems being used between them. This helps improve workflows, reduce vagueness and provide higher levels of patient care.

For example, let’s say a patient changes providers or sees a new specialist rather than their usual physician — rather than starting over from scratch and providing their personal information over and over, their electronic file can follow them. This helps to provide a new physician with all the necessary patient information to get started right away, leading to more accurate treatment and diagnosis the first time around.

An EHR follows the patient wherever they go, allowing each and every physician they come in contact with to access their history while exchanging new information with one another. Physicians can update a patient’s file in real time, allowing those in other departments and even separate facilities to access an up-to-date, accurate patient file at the point of care. If a patient forgets past medications, their provider can simply check by looking at their chart. While true interoperability still may be a ways away, it still provides numerous advantages today.

Improve Patient Care

One of the biggest and most popular reasons health organizations adopted EHR software in the first place was to provide better healthcare for their patients. As we mentioned, interoperability gives physicians a patient’s entire medical history at their fingertips. By giving them accurate and updated patient information, physicians are able to in turn provide more accurate diagnoses and treatment. This, combined with tools like health analytics, gives healthcare professionals a head start when carrying out patient care.

Additionally, inaccurate patient files can often lead to misdiagnosis, delaying the road to recovery while potentially putting patients in harm’s way. Electronic patient records also eliminate the possibility of handwriting and legibility issues. EHRs help keep patient information secure and are only accessible to authorized personnel, reducing the likelihood of misplaced, tampered or destroyed medical records.

Facilitate a Physician’s Practice

While EHRs help your physicians optimize the quality of care they provide, they also do so much more. Physicians can automate tasks such as scheduling, billing, claims management, insurance verification, revenue management and more. This frees up more time for providers to spend focusing on patients rather than dealing with administrative and clerical work. Calendar and scheduling tools can be used to prevent double-bookings, while information kept on file can help speed up the process of office visits.

Increasing overall traffic leads to more revenue opportunities because your physicians can treat more patients in a given time period. While implementing an EHR is never cheap, the financial benefits in the long run are well worth it. Additionally, incentives earned from using a certified EHR solution can help soften the blow that is initial startup fees. These solutions allow your providers to improve the quality of patient care without having to sacrifice time or money in the meantime.

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Requirements

Eligibility

It’s important to remember that only healthcare professionals are eligible to earn EHR incentives, whereas practices and hospitals as a whole do not. With that being said, many individual providers can designate a practice to receive these incentive funds on their behalf.

To be considered eligible, hospitals and health facilities must demonstrate meaningful use of their EHR, which we’ll dive into deeper soon.

The following healthcare professionals include those considered “eligible” to participate in the EHR incentive programs:

• Doctors of medicine or osteopathy
• Doctors of dental surgery of dental medicine
• Chiropractors
• Doctors of optometry
• Doctors of podiatry

When it comes to eligible facilities, such as hospitals and critical access hospitals (CAHs), many choose between medicare and medicaid PI incentive programs. There are dual eligible hospitals and CAHs which are eligible to participate both medicare and medicaid incentive programs.

Medicare-Eligible Facilities

The following hospitals are eligible to take part in the Medicare Promoting Interoperability Program:

• Subsection hospitals in all 50 states and Puerto Rico that are paid under the Inpatient Prospective Payment System (IPPS)
• CAHs
• Medicare Advantage/ MA-affiliated hospitals

Medicaid-Eligible Facilities

The following hospitals are eligible to participate in the Medicaid Promoting Interoperability Program:

• Acute care organizations (includes CAHs and cancer hospitals) with a minimum of 10% Medicaid patient volume
• Children’s hospitals (no patient volume requirements)

Dual-Eligible Facilities

As the name would imply, dual-eligible health organizations meet the requirements of both the Medicare- and Medicaid-eligible PI programs.

Meaningful Use

There are three stages for the “meaningful use requirements” for EHR programs. These three stages are measured with 10 direct objectives. The first stage of the program is the basic implementation of the software itself. The second stage is about translating the software into a useful and well integrated tool within the healthcare practice. The final stage of meaningful use is a demonstration of the improved efficiency and accuracy of the healthcare provider through the use of EHR.

Each stage has 10 specific objectives that can be tested and proven. Upon completion of each stage, providers must attest to the proper adherence to the EHR program requirements in order to qualify for the incentives. In the first year, they must only have 90 consecutive days of successful EHR implementation, and then each subsequent year will require 100% EHR compliance.

Core Objectives

The following objectives must ALL be met from everyone who participates in these incentive programs (apart from some exemptions). Participants must report on all 15 of these core objectives in order to receive an incentive payment:

• Computerized physician order entry (CPOE)
• Drug-to-drug and drug-to-allergy checks
• E-Prescribing
• Maintain up-to-date problem list of diagnoses
• Maintain active medication list
• Maintain active medication allergy list
• Record demographics
• Record smoking status (patients 13+)
• Chart changes in vital signs
• Report ambulatory clinical quality measures
• Implement clinical decision support
• Provide clinical summaries for patients (each visit)
• Provide patients with electronic copy of health information
• Protect electronic health information
• Capability to exchange key clinical data

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Menu Objectives

In addition to the 15 core objectives, there are additional objectives, called menu objectives. Physicians who want to be eligible to receive incentive payments must report on five of the 10 menu objectives listed below.

At least one of the chosen objectives must come from the public health list, consisting of:

• Submit electronic data to immunization registries
• Submit electronic syndromic surveillance data to public health agencies

The following are the remaining menu objectives to be considered:

• Drug formulary checks
• Incorporate clinical lab/test results
• Generate lists of patients for preventive and follow-up care
• Medication reconciliation
• Patient access to electronic health information
• Patient-specific education resources
• Summary of card record for transitions of care

In rare scenarios, some practices may find that some or all of these objectives are not applicable. In that case, you can claim exclusion for five of the menu objectives.

Clinical Quality Measures

Besides the above objectives, physicians must report on clinical quality measures, including three core measures as well as selecting three additional measures. Electronic clinical quality measures use data from EHRs and other health IT solutions to measure the quality of health care provided. The measuring and reporting of these measures helps ensure our healthcare system is delivering effective safe and patient-centred care in a timely manner. These clinical quality measures include many aspects, listed here:

• Patient and family engagement
• Patient safety
• Care coordination
• Population/public health
• Efficient use of healthcare resources
• Clinical processes and effectiveness

A more in-depth look about the required objectives and measures discussed above can be found here.

Solution Selection

Certified EHR

Since 2019, PI programs required all eligible professionals and hospitals to use a 2015 version of certified EHR (CEHRT) in order to meet the program’s requirements. Efficiently capturing and sharing patient data requires an EHR that stores data in a structured format. Certified EHRs give providers the ability to retrieve and transfer patient information with ease. These solutions can be used in a way to aid patient care. In other words, a certified EHR will help providers demonstrate meaningful use while meeting objectives and measures mentioned earlier.

Incentive Payouts

From 2011 to 2018, more than $24.8 billion in Medicare and $6 billion in Medicaid PI Program payments have been made to healthcare providers/organizations. As of recent times, over 642,000 eligible professionals and facilities are currently registered in these PI programs.

The Medicare PI Program has a maximum incentive of $44,000 for eligible professionals, while the maximum incentive for Medicaid PI Program professionals is $63,750. While the monetary incentives of participating in these PI programs are appealing, the penalties for not meeting requirements and meaningful use standards can be steep. Performance-based scoring methods are used to determine this exact amount that is handed out to providers, with downward payment adjustments being made as needed.

That being said, hardship exceptions can be appealed to exempt organizations from downward payment adjustments. In order to be exempt, they must show that compliance with the unmet requirement would result in a significant hardship. If the hardship application is approved, the hardship exception is valid for one payment adjustment year. Organizations must submit a new application for the coming years and may not be granted an exception for longer than five years.

Registration

Centers for Medicare and Medicaid Services (CMS) transitioned to the QualityNet system for hospitals attesting to PI programs. Registration for these programs can be done online. The Medicaid EH Registration User Guide and Medicaid EP Registration User Guide provide simple instructions for how to register for these incentive programs. Organizations who register are not required to participate in these PI programs.

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Wrapping Up

Overall, PI/EHR incentives are a way for healthcare providers to provide a better service to their patients at a reduced cost to themselves. The programs offer small offices the same opportunity as large scale hospitals to keep themselves updated with technology changes in the healthcare industry. The use of EHR is intended to create a more complete health profile for patients and ultimately lead to better treatment options long term. As a whole, PI programs are a step toward a more accurate and well-designed healthcare system for everyone.

Still have any questions about the Promoting Interoperability (EHR Incentive) programs? Has your organization reaped the benefits of these programs? Let us know below.